Advice please

[ruthelliot]

Hi folks, I've not posted in a long time though I'm still always lurking about seeing how you are all getting on. I'm looking for advice - my father in law went to doc last week with symptoms of diabetes and the nurse tested urine which was max glucose. He had bloods done and sent away. Got letter today to say he has to get apot next week to get some bloods repeated - then see doc after results back - so prob no meds for another week. I checked his blood glucose today and he is 21.2 with urine ketones 3+ and blood ketones 3.1. Now I'm out my comfort zone with T2 but should I be worried at those levels and the wait before he gets meds? Also can anyone recommend some good basic books for t2 and specifically about diet. Thanks in advance
Ruth x

 

[Mark T]

The Gretchen Becker book is a good read for Type 2 - and has some concepts that are applicable to Type 1 as well.

However, are you sure about Type 2? Its not impossible for him to be Type 1 - given those ketones.

 

[trophywench]

Yup, I'd be concerned about the ketones myself - unless he's off his food perchance so they would be 'dietary' ketones as opposed to 'DKA' type ketones.

If he feels nauseous, giddy or deathly tired - I'd say A&E immediately, frankly.

 

[ruthelliot]

Thanks for the replies. The urine and blood was at midday and he had skipped breakfast but had been eating fine prior to that so I thought still too high for dietary but as I say I'm used to a little one with T1. They are assuming T2 on the basis of age and lifestyle. It has come on quite quickly - symptoms only over the last 4 weeks. About 8 wks ago he had a 2hr post meal reading of about 6 I think when we randomly checked one day. Anyhow I took your advice and phoned nhs24 who want to see him immed so my hubby is on way with him now. Thanks again x

 

[Mark T]

Which ever way it turns out, hopefully your father in law got sorted at A&E.

 

[HOBIE]

Good luck at A&E

 

[ruthelliot]

Thanks everyone, he's home now to go back in morning, started on tablets. Think I'll be on here a lot for advice in the next wee while! X

 

[trophywench]

I'm glad they are sorting him out Ruth. Time for some sharp words with his GP surgery?

 

[Mark T]

Did the A&E remember to send him home with a meter too?

Going with the assumption that he is Type 2 (not personally convinced), there is lots of good advice in the newbies thread - other then the book that I mentioned there is also the Test, Review, Adjust advice.

A low to moderate carb diet is always a good technique for Type 2. Consider that for your little one that you would carb count something and inject insulin to cover it. Now, for Type 2 assume that the needle you are using only contains say, 3 units of insulin (YMMV) because in Type 2 you are not producing enough, because either it is ineffective or insulin resistance means you need much more to get the same effect.

From what I've read of others on here, what you need to keep an eye on is his blood glucose levels continuing to go up despite altering diet and being on medication. Type 2 medications do pretty much nothing for a Type 1.

 

[ruthelliot]

Thanks Mark, book ordered! I will keep a close eye on his glucose and ketones in the next wee while. As yet no monitor, no dietary advice just tablets and been told his GP will refer him to diabetic clinic - obviously have little faith in GP , think I'll need to be on the case constantly. I obviously know a good bit about carbs with lower GIs etc but as a rough guide how much carbs should he consume in a day/ at each meal? He has lost at least a stone in recent weeks but has 2-3 stones to lose.

 

[Mark T]

...but as a rough guide how much carbs should he consume in a day/ at each meal?...

The problem there is that it differs for everyone. I could stand 140-150g of carb per day without affecting my levels (could because I've started to creep up recently) but I'm in my 30's and probably have much different energy needs (but then, possibly not).

That's the main reason why a meter is soo useful 🙂

I think the "official advice" is a much higher level of carbohydrate per day and carbs with every meal (Aaagghhh!)

 

[ruthelliot]

Thanks Mark, I really do appreciate the advice. We've got a few spare monitors so will get him started and do my damnedest to get his GP to prescribe some strips. I really feel for him - he's terrified and has no idea where to start.

 

[trophywench]

Well - Alan Shanley has a way of putting it, doesn't he?

Eat to your meter. And then Test, Review, Adjust !

Have you ever read his Blog? http://loraldiabetes.blogspot.co.uk/

Start at 2006 and proceed LOL

Even if you have no interest in diabetes whatsoever - read his Travelogue - he goes on fantastic journeys. All sorts of exotic places, St Petersburg, China, Kerala, Paris, Oxford, KIngsbury Water Park !!

Don't make poor ole dad significantly cut his carbs all at once, if he needs to cut down - which his meter will tell him - do it say 10% at a time, otherwise he will feel even more bleurrrgghh than he probably does already.

 

[ruthelliot]

I'm glad you said that - I have just before reading this phoned him and said not to make too many changes in the first few weeks - just cut out any c**p and look at portion control and not to be scared of carbs! How long before we should see a difference with the metformin? I assume until it kicks in it will be hard to see the effects various foods have? Obviously we will test anyway to make sure he's not getting worse.

 

[Mark T]

...How long before we should see a difference with the metformin?...

It takes 2-3 weeks for Metformin to start making a difference I seem to recall.

Metformin has not effect on postprandial levels, so you can still experiment with foods. It's just as metformin has an effect the pre-meal levels will start to come down.

Although I assume they normalised his glucose levels somewhat at the hospital? - Metformin isn't going to do much against levels of 20 mmol/l.